EyeWorld India June 2015 Issue

44 EWAP CATARACT/IOL June 2015 by Ellen Stodola EyeWorld Staff Writer Controversy around immediately sequential bilateral cataract surgery ISBCS is performed around the world, but some physicians still show hesitation and concern S teve A. Arshinoff, MD, Toronto, and Kent Stiverson, MD , Denver, Colo., discussed immediately sequential bilateral cataract surgery (ISBCS) during the “Cataract Dilemmas” symposium at the 2014 ASCRS•ASOA Symposium & Congress in Boston, with Dr. Arshinoff highlighting the international perspective and Dr. Stiverson focusing on the U.S. perspective. Audience response Audience members at the symposium were asked to weigh in on the topic. Responses focused on how far apart patients are booked for cataract surgery in each eye and for what reasons bilateral cataract surgery is not performed. The 106 audience responses indicated that about 62% book cataract surgery in each eye 1 to 2 weeks apart. Nearly 30% said they book each eye 1 month apart. Meanwhile, 6.6% said they do both eyes on the same day, while just under 2% said they perform the surgeries 1 day apart. The audience was asked why they do not perform bilateral cataract surgery, with choices ranging from worries about an infection or toxic anterior segment syndrome (TASS), refractive outcomes, or reimbursement issues for the second eye. Of the 66 responses, about 21% indicated that they are worried about an infection or TASS, about 15% said they are worried about refractive outcomes, and about 12% said they are worried about reimbursement issues for the second eye. The rest, 51.52%, worried about all of these factors. Booking cataract surgery Dr. Arshinoff said the audience responses reflect that “a surprisingly large number performs ISBCS,” and a number of people perform cataract surgery 2 weeks apart at the most. “This suggests that the majority would perform ISBCS if the obstacles in the U.S. were removed,” he said. Dr. Stiverson thinks the responses of the audience indicate support for same day bilateral surgery. “Two-thirds of respondents are booking at 1 to 2 weeks,” he said. “I would have thought it would be two-thirds at 3 to 4 weeks.” When booking cataract surgery, Dr. Stiverson will do each eye on the same day 75% of the time when there are operable cataracts in both eyes. “Of these patients, 10% will call back and request different day surgery,” he said. He goes into patient consultations assuming that most will be undergoing same day surgery, but comorbidities and patient comfort can play a role in performing surgery on different days. “The fact that only 7% of doctors who responded book eyes for same day surgery would seem to support the status quo,” Dr. Stiverson said. “Conversely, I am encouraged that so many doctors are doing eyes 1 to 2 weeks apart.” Why don’t surgeons perform bilateral cataract surgery? The concerns expressed in the second question were evenly split among the three choices, Dr. Audience members who do not perform immediately sequential bilateral cataract surgery were asked to give their reasons. Source: ASCRS